Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda

Abstract

Background: Health worker retention in rural and underserved areas remains a persisting problem in many low and middle income countries, and this directly affects the quality of health services offered. Objective: This paper explores the drivers of long-term retention and describes health worker coping mechanisms in rural Uganda. Methods: A descriptive qualitative study explored the factors that motivated health workers to stay, in three rural districts of Uganda: Kamuli, Pallisa, and Kibuku. In-depth interviews conducted among health workers who have been retained for at least 10 years explored factors motivating the health workers to stay within the district, opportunities, and the benefits of staying. Results: Twenty-one health workers participated. Ten of them male and 11 female with the age range of 33–51 years. The mean duration of stay among the participants was 13, 15, and 26 years for Kamuli, Kibuku, and Pallisa respectively. Long-term retention was related to personal factors, such as having family ties, community ties, and opportunities to invest. The decentralization policy and pension benefits also kept workers in place. Opportunities for promotion or leadership motivated long stay only if they came with financial benefits. Workload reportedly increased over the years, but staffing and emoluments had not increased. Multiple job, family support, and community support helped health workers cope with the costs of living, and holding a secure pensionable government job was valued more highly than seeking uncertain job opportunities elsewhere. Conclusion: The interplay between the costs of leaving and the benefit of staying is demonstrated. Family proximity, community ties, job security, and pension enhance staying, while higher costs of living and an unpredictable employment market make leaving risky. Health workers should be able to access investment opportunities in order to cope with inadequate remuneration. Promotions and leadership opportunities only motivate if accompanied by financial benefits.

Maternal and neonatal implementation for equitable systems. A study design paper

“…In this supplement, we share a special issue of 10 different papers of which this paper is part. The rest of the nine papers share specific results [25–32]. In addition to this design paper, there is one more methodological paper that describes the PAR approach in more detail [33].…”

“…One of them describes the use of community health workers [29], another presents the achievements made through the support supervision component of the intervention [30] and the third shows the achievements and challenges of implementing the mentorship component of the program [31]. The final paper explores factors that contribute to the retention of health workers [32]. Although interventions such as this one may build the capacity of health workers, these health workers are often not retained for long periods.…”

Assessing the level of institutionalization of donor-funded anti-retroviral therapy (ART) programs in health facilities in Uganda: implications for program sustainability

“…Our study brings into critical focus the challenges of health worker retention in Uganda in the context of unattractive monetary reward systems, especially in the public sector, and the need for devising non-monetary incentives [22,47]. Studies conducted in Uganda show that beyond monetary rewards, health workers are motivated by the desire to serve rural folk in their home districts where they can leverage their social capital as well as tend to food gardens to supplement their meager salaries [47].…”

“…Studies conducted in Uganda show that beyond monetary rewards, health workers are motivated by the desire to serve rural folk in their home districts where they can leverage their social capital as well as tend to food gardens to supplement their meager salaries [47]. Several studies highlight the role of leadership styles in motivating the workforce [17,18,22,33].…”

Estimating the cost of implementing a facility and community score card for maternal and newborn care service delivery in a rural district in Uganda

“…This costing analysis was part of the FHS-CSC study in Kibuku, a rural district in Eastern Uganda. Kibuku district is a typical rural district setting in Uganda with a population of approximately 202,033 people and is approximated 200 km north-east of Kampala, the capital city of Uganda [ 19 , 20 ]. Kibuku district predominately has rural population, approximately 184,597 people, with low literacy levels [ 21 ] and whose occupations mainly include agriculture, petty trading, brick making, among others [ 22 ].…”